SUFU 2019: Numerous Socioeconomic and Ethnic Factors Predict Receiving Advanced OAB Therapies in a Commercially Insured Population

Miami, FL ( Studies suggest ethnic and socioeconomic disparities exist among patients with overactive bladder (OAB). Prior studies have found that OAB symptoms occur at higher rates in blacks and Hispanics and at lower rates in Asians. Furthermore, patients with lower incomes and educational backgrounds have been found to be less likely to discuss urinary incontinence. Minority Medicare populations have also been shown to be less likely to undergo sacral neuromodulation therapy (SNS) than white patients.

Raveen Syan, MD, and her group at Stanford University sought to determine whether ethnic and socioeconomic disparities exist for third-line OAB therapies amongst commercially insured patients.

Using data from the Optum database, a national administrative health, and pharmacy claims database, the Stanford group identified patients with non-neurogenic OAB between the years of 2003-2016, using ICD9 and ICD10 diagnosis codes. Exclusion criteria included those patients less than 18 years of age and those with neurogenic bladders. Patient demographics and treatment interventions were collected, including oral medication therapies (anticholinergic and beta3 agonists) and advanced therapies (OnabotulinumtoxinA (BTX), SNS, and peripheral tibial nerve stimulation (PTNS)).

3,501,010 patients with OAB were identified, of whom 630,495 (18%) were treated with medical therapies. Oral therapy use was lowest amongst Asians (12%), compared to a rate of 17-20% amongst Hispanics, whites, blacks, and others (p<0.05). The rate of advanced therapy use in medically treated patients was 3-4% in all ethnic groups. Of those undergoing advanced therapies, Asians were the most likely group to undergo BTX treatments and least likely to undergo PTNS compared to all other races/ethnicities (p<0.05). Whites and Blacks had similar rates of use of BTX, SNS and PTNS (Figure 1).
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Occupation status was known in 629,909 patients. On multivariate analysis of these patients (Table 1), predictors of advanced OAB therapy use were female gender (OR 2.03), age <65 (OR 1.14), income <$75,000 (OR 1.14), prior use of oral OAB medications (OR 2.29), being of a region other than the Northeast US. Patients of a minority race/ethnicity (OR 0.76) and those without a high school diploma (OR 0.52) were less likely to receive advanced OAB therapies (p<0.05).

By utilizing the Optum database, the study authors could evaluate both racial and socioeconomic differences in OAB patients, all of whom are commercially insured. They were, therefore, able to conclude that age, gender, race/ethnicity, education level, occupation level, and region affect OAB treatment patterns in the US. 

Presented by Raveen Syan, MD, Department of Urology, Stanford University School of Medicine, Palo Alto, California

Written by: Judy Choi, MD, Assistant Professor, Department of Urology, University of California, Irvine @judymchoi at the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction Winter Meeting, SUFU 2019, February 26 - March 2, 2019, Miami, Florida